The chasing zero department: making idealized design a reality.

OBJECTIVES: Leaders representing healthcare quality, purchasing, and certifying sectors convened at a national leadership meeting to address the issue of Healthcare-Associated Infections (HAIs). A session entitled "The Quality Choir: A Call to Action For Hospital Executives" featured harmonization partner organizations for the National Quality Forum Safe Practices (SPs) for Better Healthcare-2009 Update. (NQF SPs) The objective of the meeting was to determine if zero HAIs should be the improvement target for hospitals and what a Chasing Zero Department (CZD) should be like. METHODS: Discussion and consensus building among these experts determined what a CZD would look like and what it would take to implement it. RESULTS: Given that zero HAIs must be the goal, Hospital Infection Control Departments need to be restructured. CONCLUSION: Key design issues to the CZD addresses leadership, resources, and systems. Leadership: CEOs and boards must communicate to the organization that the typical Infection Control Group might be restructured into a CZD. The leader must provide "will, ideas and execution," recognize the power of collaboration, provide funding, and establish a roadmap through use of NQF SPs. RESOURCES: Funding for these efforts must be provided. Chief Financial Officers (CFOs) need to understand that zero HAIs will preserve revenue. Systems: Change can be made through leaders' championship, use of SPs, performing improvement, information flow and Automated Infection Identification and Mitigation System (AIIMS). These are the key to systems change toward zero HAIs.

Chasing zero: can reality meet the rhetoric?

OBJECTIVES: Leaders from healthcare quality, purchasing, and certifying sectors convened at a national leadership meeting held September 8-9, 2008 in Washington, DC to address issues of Hospital-Acquired Infections (HAIs). This paper provides opinion interviews from leaders who spoke at a session entitled "The Quality Choir: A Call to Action For Hospital Executives" on whether zero HAIs should be the goal of our Hospitals. METHODS: The successes of many hospitals in dramatically reducing their infection rates were examined toward goals of "Chasing Zero" infections. RESULTS: They agreed that the rhetoric of Chasing Zero HAIs must become reality, that anything less than aspiring to eradicate the risk of giving infections to patients for whom we deliver care is unacceptable. CONCLUSION: Every hospital leader must re-evaluate the strategy, structure, and function of their infection control and prevention services toward the following parameters: Zero HAIs must be the goal. Purchasers will no longer wait for hospital losses to act. Forces of harmonization are an unprecedented force. New-found hospitals' harmonized standards can move from "playing defense" to "playing offense" against HAIs. Leaders must ignite the passion of teams to make rhetoric a reality. Real stories about real people communicate through real caregiver values. The power trio of governance, administrative, and medical leaders must turn their potential energy into action. We have the "what" we need to aim for, the "how" to get the job done, and it is now about engaging the "who" to seize the opportunity. Embrace champions to lead the charge.

Five system barriers to achieving ultrasafe health care.

Although debate continues over estimates of the amount of preventable medical harm that occurs in health care, there seems to be a consensus that health care is not as safe and reliable as it might be. It is often assumed that copying and adapting the success stories of nonmedical industries, such as civil aviation and nuclear power, will make medicine as safe as these industries. However, the solution is not that simple. This article explains why a benchmarking approach to safety in high-risk industries is needed to help translate lessons so that they are usable and long lasting in health care. The most important difference among industries lies not so much in the pertinent safety toolkit, which is similar for most industries, but in an industry's willingness to abandon historical and cultural precedents and beliefs that are linked to performance and autonomy, in a constant drive toward a culture of safety. Five successive systemic barriers currently prevent health care from becoming an ultrasafe industrial system: the need to limit the discretion of workers, the need to reduce worker autonomy, the need to make the transition from a craftsmanship mindset to that of equivalent actors, the need for system-level (senior leadership) arbitration to optimize safety strategies, and the need for simplification. Finally, health care must overcome 3 unique problems: a wide range of risk among medical specialties, difficulty in defining medical error, and various structural constraints (such as public demand, teaching role, and chronic shortage of staff). Without such a framework to guide development, ongoing efforts to improve safety by adopting the safety strategies of other industries may yield reduced dividends. Rapid progress is possible only if the health care industry is willing to address these structural constraints needed to overcome the 5 barriers to ultrasafe performance.

Pursuing perfection: an interview with Don Berwick and Michael Rothman. Interview by Andrea Kabcenell and Jane Roessner.

Don Berwick and Michael Rothman discuss the Pursuing Perfection initiative, which is intended to help health care organizations integrate improvement work into day-to-day life, with systemwide changes in infrastructure, project management, care, and leadership.

Redesigning cancer care.

Patients with cancer in the UK suffer more delays and worse survival than those in many other European states. The national cancer plan has set ambitious targets for improved care. The cancer services collaborative is using improvement methods to reduce delays and improve the service for patients. The nine cancer networks using these methods have cut waiting times and improved patients' experiences of care.